ACA requires chronic care coverage

Editor’s note: This is the final story in a series to explain the 10 essential health benefits required under the Affordable Care Act and explore what effect those requirements will have on patients and caregivers.

“We meet and monitor care,” said Dayna Patterson, nurse manager and quality control manager at CHCCM. “We have a health-care plan that focuses on diabetes and cardiovascular disease. We’re also lucky enough to have in-house behavioral health to complete screenings and collaborate with the medical side.”

Chronic disease management, paired with preventive and wellness services, is one of 10 essential health benefits required for every health insurance plan to cover under the Affordable Care Act (ACA) — a comprehensive health-care law signed by President Barack Obama in 2010. Other required benefits include services such as inpatient hospital stays and laboratory services.

Patterson said the health benefit mandate doesn’t change much for the health center.

“We’ve always been here for patients, regardless of their ability to pay,” she said. “But, it (the ACA) does allow patients more options for health care.”

She said it’s great that patients can now play a bigger part in the delivery of their care and disease management.

“I think if they can understand their health care and play a role, it gives them a sense of ownership and accountability,” she said. “Also, the more you educate, the better they can understand and control their chronic disease.”

Your questions

The News Tribune received one question this week about the ACA:

Q: Can a child be covered under the ACA without one of the parents being covered? What is the criteria for a child to qualify?

A: According to the National Academy for State Health Policy, “exchanges are required to offer child-only plans that are available only to children up to age 21.”

But, a child may qualify for the Children’s Health Insurance Program (CHIP), which according to healthcare.gov, “provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.”

If you fill out a Health Insurance Marketplace application at healthcare.gov, it will tell you at the end of the application what programs you or your child qualifies for.